Amenorrhea

 

• Definition and causes

  No periods.

  Primary amenorrhea

  • Failure to start periods.
  • May be a genetic or chromosomal cause, including Turner's and fragile X.

  Secondary amenorrhea

  Periods stop for more than 6 months, caused by STOP TAMPON.

  Usually due to HPO axis dysfunction:

  • Stress
  • Pituitary Tumour.
  • Over-exercise and weight loss.
  • Psychiatric: anorexia nervosa.

  Others:

  • Thyrotoxicosis
  • Asherman's syndrome: adhesions.
  • Early Menopause.
  • PCOS
  • Ovarian tumour.
  • Neonatal: post-pregnancy and breastfeeding.

• Investigations

  Rule out pregnancy.

  Primary amenorrhea:

  • Consider if 16 years old and has not experienced menarche, or is 14 years old and has had no breast development.
  • If chromosomal sex disorder suspected, examine genitalia and consider karyotype testing.

  Secondary amenorrhea:

  • ↑LH and ↑testosterone in PCOS (though both can be normal).
  • ↑LH and ↑FSH in ovarian failure, inc. premature menopause.
  • ↓LH and ↓FSH in hypothalamic dysfunction e.g. excess exercise.
  • ↑Prolactin suggests prolactinoma. Follow up with MRI. Milder elevations can also be seen with stress.
  • TFT

• Management

  • Treat underlying cause.
  • In early menopause, consider HRT.